Coarticulation Therapy: Tips, Runs and Opinions

You may notice the word "run" in the headline. What does the word mean, and how does it figure into my therapy technique? A run is the sequence of syllabic utterances that end in a predetermined sentence. The final utterance contains several productions of the target phoneme in an environment that supports its correct production.

Runs contain a series of ever more complex and varied environments. Beginning runs contain Cv syllables in strings of increasing size. "Making a run" is about programming meaning on a level that the child's language system can handle with ease. The child's ability to produce a specific phoneme or syllable and to suppress the targeted phonological process in incremental steps is at the center of this therapy.

When a child presents with the phonological process of stopping t/s, it is necessary to establish the feature of frication in the syllabic sequence. From experience, it is far easier to elicit or teach a vC syllable where C is /s/ than it is to elicit a Cv syllable where C is /s/. The child who substitutes t/s usually will produce t/sh and probably will produce p/f and reduce a ch into /t/ and a /j/ (as in "jar") into a /d/. In the initial stage of therapy, the child will have a tendency to produce "vts," "vst" or "stv" when asked to produce a vC or Cv syllable.

Once vC is fixed and therapy moves on to vCv /aisi/ or /aise/, the child's tendency to produce "vstv" needs to be addressed. The child has a history of stopping the air by moving the tip of the tongue to the area around the alveolar ridge, which needs to be corrected. One technique that I have used with 100 percent success is to teach /ais/, pause for one second, and then produce /hi/. The pause then is modified and shortened while pointing out tongue position and movement. Clinicians must have patience because it will take several sessions to achieve a proper vCv syllable. Once it is achieved, the child can move on to a vCvCv sequence.

At the heart of this therapy is the vCv syllable. Once the student masters this, the rest is downhill. The first strings that are presented to the child contain a predominance of the /s/ sound. One sequence would be /sisʌ/,/sisʌm/, /aisisʌm/, /esı/, /esız/, /fesız/ and /aisisʌmfesız/. There are five fricatives in the last sequence, and four of the five fricatives are /s/ or /z/. The sixth consonant is a continuant, and no competing consonants were presented. Another sequence would be /ais/ and /aise/. This syllable could be developed with the previously cited technique of /ais/ plus /he/ if the child produces /aiste/. The child then could produce the sequence /saise/ and /jεsaise (pause) εs/ (yes, I say "s"). When the string is being produced, there is no stopping in the sequence. One last sequence before a vCCv syllable is introduced could be /εs/, /εsı/, /εsız/ and /εsızowizi/ ("s" is so easy). Clinicians also could prolong the /s/ in the string.

When correcting the phonological process of final consonant deletion, traditional therapy deals with the problem on the single word level, with the child producing a set of minimal pairs (/so/ and /sop/) accompanied by a pair of pictures. One depicts a person sewing, and the other shows a bar of soap. Therapy on the single word level using any technique-whether it's minimal pairs or cycling through a series of steps accompanied by auditory bombardment-is ultimately ineffectual because it does not control for or take into account the effects of coarticulation. The blending of movement and sound is left out of every previous type of therapy.

The phonological processes of deletion of unstressed syllables, gliding of medial consonants, and open syllables can be addressed with a number of steps. Phonological processes occur in the string of syllables that is spontaneous speech. A phonological process is a descriptive method of what is happening. It establishes a rule system to turn unintelligible speech into intelligible speech. Applying coarticulation, construction of the vCv syllable, and the blending of words cancels out the debilitating effects of phonological processes. The final consonant in a single word-for example, the /t/ in /pUt/, where the /t/ is released-is not the same sound as in the sequence for "put in" (/pUdın/). This is why traditional therapy fails and why therapists often say that a child is intelligible at the word level but difficult to understand when speaking in sentences or spontaneous speech.

A therapy that uses phonological reasoning but focuses on fixing the single word when attempting to increase a child's conversational intelligibility seems counter-productive. A similar phenomenon exists when regular or special education teachers teach reading using their version of phonics. The child is made to sound out the word "p-ı-t," says "pit," and then reads the sentence with disrupted prosody because they didn't teach coarticulation.

My therapy for final consonant deletion first builds up the syllable at the end of a word. When a vowel is added, the blending of words occurs, and the child learns natural prosody. The effects of coarticulation cross word boundaries. One run or sequence of development could be /dıdı/, //pUdıdı/, /pUdının /aipUdıdınə/, /aipUdıdınəkʌp/ and /aipUdıdınəkʌpəti/ ("I put it in a cup of tea"). While working on remediating the final consonant deletion process, the child practices and learns unstressed syllables. The child learns that the movement of the tip of the tongue to the alveolar ridge is important. This supports the suppression of the process of gliding through medial consonants, such as /pUjıjın/ vs. /pUdıdın/ ("Put it in"). When I first entered the field as a professional, one of the first children I saw had no consonants in his speech. He substituted glottal stops for consonants in the string of syllables. Using my technique, the child became a normal speaker within five months.

Recently, I saw a child who presented with t/k and the omission of middle syllables. The child produced /sıʔər/ for sister and /træʔər/ for cracker. When teaching the child to produce the /st/ blend in "sister," it was necessary first to simplify the word into two syllables. Each syllable then was established as an entity in the child's production using verbal-visual cues. First, /sıs/ was built up with a prolonged final /s/. Next, /dər/ was established in rapid syllables /dərdərdər/. Finally, the word was built up in a sequence of two syllables using a verbal-visual cue and a repeated model of /sıs/ /dər/.

For verbal-visual cues the child said /sis/ when the adult raised his left hand and said /dər/ when the adult raised his right hand. The child needed to learn the timing and not be impulsive. The word "sister" (/sısdər/) was established at 100 percent accuracy in five out of five productions. It then was made into a longer series of syllables by adding /mais/, /maisıs/, /maisisdər/ and maisısdər.

In the end the clinician asked the child to construct simple sentences with a verb (i.e., "My sister is running").

The following technique allows clinicians to control the child's productions at the syllabic level, as well as the context and syllabic environment. To help a child produce the word "cracker" (/træʔər/), elicit /ek/, /ekə/ and then /ekə kə/. The /kræ/ syllable is introduced, and /əkrækə/ is produced.

Make sure the child practices each syllabic utterance a number of times.

The process of velar fronting further can be addressed by presenting /ekəkəp/, /mekəkəp/ and /aimekəkəp/. The therapist then can introduce a third syllable with /k/: /kəkəkə/. This eventually will be built up into two different words. Already their parts are blended, and the child has experienced normal speed, movement and prosody.

The clinician can add new parts that will allow the child to use the vowels. This becomes /aikıkəkæn/ or /aimekakUki/ . The string becomes more complex and the meaning changes as different phonemes are placed into the sequence. Phonemes that are not competitive to the child's error sound initially should be placed into the sequence. Phrases such as /aipıkəkon/ /aimekəkʌpkUfi/ then are constructed and practiced.

Once /k/ has been established at 100 percent accuracy in phrases that do not contain competitive phonemes or the error sound, /t/ or /d/ can be introduced. These sounds contain interfering features that can instigate the errors in the phonological process if used too early in therapy.

The phrase with the sequence /kʌpə/ ("cup a") is used instead of /kʌpʌv/ ("cup of") because this is how "cup of" is said in running speech. Have the child produce /tekə/, /aitekə/ and then /aitekətako/ ("I take a taco"). Note that the pattern of movement is "t-k-t-k." Another complete phrase is /aigatəgotəkæmp ("I got to go to camp").

At a high level of proficiency, the child should be able to produce complex syllabic sequences with age-appropriate content at 100 percent intelligibility. This is the end result of teaching coarticulated strings of syllables in a controlled manner. The single word level is never employed, meaning is layered onto the syllabic string, and intelligibility is programmed into the child's speech.

Steven Siegelman is on staff at the Anchorage School District in Anchorage, AK. His last article in ADVANCE was "Coarticulation Therapy" in the June 23, 2008, issue. He can be contacted at ssiegelman@yahoo.com.

Hi Sir,
I wonder if your process will be useful for a seven year old girl that has a cerebral palsy handicap and can not produce words completely. She is unintelligible in continuous speech. I tried to teach her words of two and three syllables as separate units and she became able to pronounce a few words correctly in two years. It is slow consuming and boring. Thank you for your kindness.

eman gad, speech therapist, complex

January 22, 2013

kuwait

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